2008 Symposium

Moving Forward: Sector-based Breakout Sessions

Participants Create Sector-Specific Action Steps for Reform

Symposium participants divided into sector groups (users of care, providers of care and purchasers of care) to brainstorm and prioritize actions that would ensure the future of quality care. The goal was to identify five concrete action steps that can make the biggest difference for patients.

Users of Care

More than 100 patients and patient advocates engaged in a wide-ranging discussion moderated by former CNN Anchor Aaron Brown, developing a list of 17 possible action steps for private-sector reforms.

A significant element of the discussion was over the definition of patient, or consumer, as evidenced by the fifth-place action steps: "Define a minimum standard benefit package that realigns the health system toward improving health rather than treating disease." The idea was that the system shouldn't just focus on people when they become sick, or "patients."

Other action steps in the top five included:

• Establish a secure electronic medical system – make the electronic medical record portable, interoperable and broadly available to entire care team (includes X-rays, etc.)
• Provide complete and accurate information so patients can make informed decisions about their care, includes visibility for adverse events/outcomes.
• Center care around the individual and families, and coordinate all aspects of patient care. Patients must be active participants in this process.
• Create a simpler system (i.e. coordinated care team), with a defined leader (primary care or specialist) who is accessible to me, and coordinates/advocates their care of acute and chronic conditions – advocate to improve quality/efficiency based on evidence.

See full list.

Purchasers of Care

Payers – employers, government representatives, health plans, providers and patients – gathered to address how the payment system could be reformed to support the goal of value within American health care.

"Payers aren't paying for what they want," Laura Tollen, Kaiser Permanente. "The number one thing that has to change is the way we pay for care."

The group brainstormed more than 40 ideas, and ranked the following six action steps as top priorities:

• Reward providers who generate good outcomes.
• Need to have all physicians computerize medical records.
• Establish coordinated care team as a model for primary care of acute and chronic conditions. Reward primary care physicians to coordinate care.
• Stop paying for "never events" – care that causes avoidable harm.
• Create a patient-controlled health record for everyone that includes not only their records, but also personalized pertinent information tailored to their condition/situation.
• Integrate people like dieticians and nurse practitioners into new care models that reinforce the general practice.

See full list.

Providers of Care

A group of health care providers advocated changing the reimbursement system to reward prevention and quality.  That was the highest ranking of 18 action steps agreed on at the breakout session.
 
Following are the top six action steps prioritized by the participants.

• Make the case for payment reform/properly aligned incentives:
  • prevention/wellness-based
  • outcomes-based
  • new form of capitation
  • receptiveness for new payment modalities (e.g. care coordination)
  • reimburse for "virtual internet appts."
• Universal use of interoperable clinical information technology (common language, systems that talk to each other).
• Develop programs for high-impact and/or high-cost services (e.g. end-of-life care, preventive, chronic diseases, vulnerable populations).
• Adopt national quality/ performance standards and report them publicly.
• Restructure care provision and payment to support coordination of care (e.g. promotion of "care coordination").
• Agree to a small set of national health care goals:  reduce injuries, reduce costs, reduce inpatient hospitalizations over three years

 See full list.